I was recently sent this infographic from The Mount Sinai Hospital in New York.

Infographics can be useful summaries.  But sometimes when we summarize information, we can miss important things.  How do you think this infographic does?

Source: Mount Sinai Medical Center

From the Headache and Migraine News Blog

Headache Infographic – What do you think?

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Clinical trials are tricky – one can say one thing, one can say another.  But what if people with a financial interest could hide the ones you didn’t like, and only use the ones you did like?

A series of studies in the British Medical Journal suggest that clinical trials are missing – trials that may say something quite different than what the public is hearing.

In the United States, the government is trying to tighten up on requirements for clinical trials.  One of these regulations is that all eligible clinical trials must be reported (on ClinicalTrials.gov) within one year of the study’s conclusion.  This came into effect in 2007.

This database has an impressive list of studies – currently 119,213 trials from 178 countries.  So whether or not trials are reported truly has a global impact.

So has the new requirement solved the problem?  Not a chance.  One study found that only 22% of the eligible trials had been reported after 12 months!  (see Compliance with mandatory reporting of clinical trial results on ClinicalTrials.gov)  Another study found that 50% of trials funded by the National Institutes of Health were published after 30 months, and a third of them were still unpublished after 51 months.  (see Publication of NIH funded trials registered in ClinicalTrials.gov)  Yes, that’s over 4 years!

Another study found that even when studies were reported on Medline (an online database of trials), they weren’t properly tagged and indexed.  (see Understanding why evidence from randomised clinical trials may not be retrieved from Medline)

–>>> This means basically that someone could do a well-designed clinical trial related to cluster headache or migraine, then not report the results for a few years.  Even when they do report it, they can leave off tags so that no one can find it.  Even if they do find it, many will miss studies that are so old.

Why is this happening?  Don’t scientists want to publish their work?

Admittedly, some of this could come from a misunderstanding of the rules, laziness, simple mistakes, and so forth.  There’s also time and expense to consider – it may be easier for a large company to publish than a smaller one with limited resources.

But the reality is that many of these studies are sponsored by the companies that sell you the medication you use.  If a study says something the drug company doesn’t like – the study may just disappear.  And that’s a scary thought.

Often researchers will publish a meta-analysis of the available studies.  For example they could take the data from 12 trials of a certain drug, and tell us that, according to 8 of the studies, the drug is very effective.  That sounds good until you realize there could be 12 more trials out there somewhere that say the opposite.  One study found just that – the missing data often contradicted what the meta-analysis studies were telling us.  (see Effect of reporting bias on meta-analyses of drug trials: reanalysis of meta-analyses)

The answer isn’t easy.  Clinical trials can be tricky to regulate.  And it’s even harder if you’re a small fish playing in the same pond with the huge drug companies.

But if the rules are there, they need to be enforced.  And the public needs to know when they’re not being enforced.

The world of clinical trials is not as pure, easy to understand, and efficient as many people believe.  It’s more important than ever for the buyer to beware – do your own research, be cautious, and don’t believe everything you read – even if it’s in a medical journal.  What’s missing may change a whole lot.

From the Headache and Migraine News Blog

The Case of the Missing Studies: Patients missing critical information

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There may be few surprises in the overall message of this video (although some of the details are quite interesting), but we all need motivation… and what a great way to start a Monday!

The author is Dr. Mike Evans.  Dr. Evans is founder of the Health Design Lab at the Li Ka Shing Knowledge Institute, an Associate Professor of Family Medicine and Public Health at the University of Toronto, and a staff physician at St. Michael’s Hospital.  Check it out…

From the Headache and Migraine News Blog

23 and 1/2 hours: What is the single best thing we can do for our health?

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This past summer at the annual conference of the American Headache Society, researchers and specialists discussed a something that we’ve known about for a long time – but still don’t take full advantage of.  That is, the premonitory phase of a migraine attack (formerly called prodrome).

Some people call it the first part of a migraine attack – others talk about it as a "warning phase".  But whatever you call it, it’s a time when there are symptoms before the full-blown symptoms at the height of an attack.

Researchers are especially interested in the premonitory phase because of the possibility of treating migraine before it gets out-of-hand.

What are some of these early-warning symptoms?  Dr. R. Allan Purdy suggests that mood changes are common – sadness or euphoria, for example.  Also, yawning, increased sensitivity to light and sound, trouble with concentration, paleness, and fatigue.  Sometime patients just "know" that a migraine attack is coming.

Dr. Purdy says,"Migraine is for many people a lightning storm that starts hours or day similar to gathering clouds before the storm, followed by the thunderous pain of the migraine headache.  The premonitory phase is well-documented but only recently have scientists considered if migraine can be treated before a patient is in full attack mode."

Some believe that, for example, taking triptans early in an attack can greatly increase your chances of successfully treating the symptoms.

What does Dr. Purdy advise?  "Until we fully understand the neurobiology of this phenomenon, our advice to patients is to stay alert to the presence of these symptoms and slow down to allow the body to adjust to what maybe coming if a migraine occurs."

Be aware, slow down, and try treating the migraine early.  Have you found that doing these things makes a difference in your symptoms?

via: Many migraine sufferers can predict their migraine attack — may create new treatment possibilities

More about premonitory symptoms and treating migraine

From the Headache and Migraine News Blog

The Gathering Storm: Predicting Migraine Attacks

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What if you could have a simple blood test done which could confirm your diagnosis of migraine – and also put you on the road to proper treatment?

True, scientific, individualized treatment is something we’ve been promised for years – but still there’s no good genetic test or blood test or any other kind of test that can diagnose migraine every time and tell you which treatment will be the most effective.

But that’s not to say that blood tests (or other types of tests) are useless.  As a matter of fact, there is a blood test that may help some migraine patients discover an important treatment for them.  And it’s not only helpful for migraine patients, but for those with depression – and often one patient is dealing with both issues.

And there’s more.

If this test comes up positive, it may also warn you of a higher risk of stroke and heart disease.  Sound familiar?  Yes, migraine patients (at least some) do seem to have a higher risk of stroke and heart disease.

Now, we’re talking about a simple test that can help you treat migraine, depression, and your risk of heart disease.  I should ask those of you with migraine – or migraine and depression – have you ever heard of such a thing?  Have you had a blood test done?  Some of you I hope will be saying yes.  Others of you are wondering why no doctor has sent you for blood work before.

And that would be a good question.

What is the test?  It’s a homocysteine test.

Homocysteine is an amino acid that converts into another amino acid known as cysteine.  If it’s not converting properly, homocysteine levels rise – and those high levels are linked to the heart disease and to depression.

There’s a link to migraine as well.  Those who suffer from migraine with aura in particular seem more likely to have high homocysteine levels.  (See The relationship between homocysteine and genes of folate-related enzymes in migraine patients)

In studies of both men and women, high levels were associated with depression, and in many cases lowering homocysteine levels helped to treat the depression significantly.  It has been hypothesized that the high levels caused vascular disease and neurotransmitter deficiency, which in turn had an impact on mood.  (See The homocysteine hypothesis of depression.)

So just how to all these things fit together?  Research is still being done to understand the connection.  But there is a connection.

Before we go any further, let’s be clear.  We’re not saying homocysteine is a cause of migraine (it could be a trigger, or a result), and we’re not saying that everyone with depression or migraine has high homocysteine levels.  And not everyone with high levels is depressed or has migraine disease.

But here’s the problem.  It’s very likely that many people suffering from migraine and depression could be helped by dealing with this problem – a problem detected by a simple blood test.  But the blood work has never been done.  Instead, they’re on two or three medications.

Solving the Problem

So what do you do for high homocysteine levels?

This blood test often goes together with other tests, checking levels of folate, vitamins B12 and B6, and zinc.  You see, these vitamins and minerals help with the conversion of homocysteine into cysteine.  High homocysteine levels can be an early detector of deficiency.

A proper checkup needs to go along with the blood test – it’s not just a matter of checking the numbers.  For example, Dr. Alexander Mauskop of the New York Headache Clinic points out that you could have high levels of B12 and yet still have deficiency – due to problems with the transport of B12 into the blood cells.  (See Homocysteine and migraine)

The solution is to make sure proper levels of folate (what folic acid or B9 is in your body), vitamins B12 and B6, and zinc are getting where they need to go in your body.

That doesn’t mean taking a B complex vitamin.  It usually means taking higher amounts of folic acid (B9) and B12 than you would find in that B complex pill from the drugstore.  And it may mean taking a sublingual version, or an injection.  B12 sublingual tablets like these have helped some people.

A good doctor will also help you look at your diet, which could be contributing to the deficiency, and lifestyle issues such as smoking.

The point is, once you are aware of a deficiency, the treatment will very much depend on your individual case, because a number of things can cause the high homocysteine levels.  Patients who have tried taking certain vitamins and think it "didn’t work" may need a more complete check-up by a migraine specialist.  A different series of vitamins, or different types, or a change in medication may be required to solve the problem.

Though it may not help everyone, this simple test will probably get many on the road to a better treatment.  Isn’t it worth talking to your doctor about?

For more, read Can a Simple Blood Test Solve Depression? and Homocysteine and migraine

From the Headache and Migraine News Blog

A Blood Test For Migraine?

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Pain around the sinus cavity.  Congestion.  Post-nasal drip.  Fatigue.  You’re feeling hot, and you have a headache.

You head to the pharmacy, and get a nasal spray.  You come home and have a good sleep.  Finally, the symptoms begin to subside.

All’s well that ends well, right?  You’ve beat sinusitis again.  Problem is, it probably wasn’t sinusitis at all.

Some of you caught on, didn’t you?  This was most likely a migraine attack, not sinusitis at all.  Did you notice the clues?

Clue #1:  You’re feeling hot.  Feeling hot, but if you take your temperature, you most likely didn’t have a fever.  With sinusitis, you may not only feel hot but have a fever.

Clue #2:  The symptoms begin to subside.  That was pretty fast for sinusitis.  First, nasal sprays are not always recommended – it depends on your specific condition.  Even if they are recommended, if the sinusitis goes away within a few hours, you’ve probably had a migraine attack.  The symptoms are more likely to last days and get worse gradually and subside gradually.

Clue #3:  We didn’t mention some key symptoms of sinus headache.  These may include yellowish or greenish mucus.  Sore throat.  And cough.

The tricky thing is that these are all possible symptoms of sinusitis, but sometimes the sinus headache comes without the upper respiratory symptoms at all.  That’s right – you may get migraine with congestion and facial pressure, and sinus headache without!

So here are some more clues to help you discover a sinus headache.  First, the gradual onset.  Second, sinus headaches rarely come with nausea, and you’re usually not bothered as much by noise and light.  Of course, it is possible to get a migraine attack within a sinus headache!

If we rely on the statistics, chances are you are having a migraine attack, or in rare cases a migraine along with sinusitis.  Don’t run to the store for a nasal spray.  Get a proper diagnosis, especially if it’s happening on a regular basis.  Leaving either migraine or sinusitis untreated can lead to worse problems later on, and the treatment is different for each.

For more, read Are you getting sinus headache symptoms?

From the Headache and Migraine News Blog

Sinus Headache – Did You Really Beat It?

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What exactly is causing that migraine headache?  Yes, we know that headache is only one possible symptom of migraine.  Not everyone with a migraine attack has a headache.  But let’s face it, the headache is a common symptom.  But why does it happen in the first place?

The headache is a part of the chain reaction that happens during a migraine attack.  Long into an attack, messages start to be sent in earnest to nerves in the head and blood vessels from the brain, and back to the brain again.

So long before most people feel pain, the "migraine attack" has already been happening for quite some time.

Once doctors believed that changes in blood vessels were actually the cause of migraine.  Few believe that today – although there is a lot of discussion about just how blood vessels fit into the chain reaction of migraine.

However, at various points in a migraine attack, blood vessels do (usually) get larger and smaller (vasodilation and vasoconstriction).  (Note: vasodilation does not always occur in a migraine attack)

When vasodilation occurs in an attack, what typically happens?

• Vasodilation:  Blood vessels are like "smart pipes" that control blood flow in the body.  So when vasodilation occurs, the blood vessels grow larger and allow more blood to flow.  And what typically happens with increased blood flow?  The area becomes warm and perhaps even red.  The blood flow may feel "over the top" – the pressure will increase and begin to feel uncomfortable.
• Vascular permeability:  Another thing that happens is that spaces appear in the walls of the blood vessels, allowing some materials to pass through.  Blood plasma, the material that carries blood cells, leaks through.  Now there is an increase in fluid in the area, causing more of a feeling of pressure and swelling.  When there is an injury such as a cut, this allows materials to enter the area which can help fight invading bacteria.  In an autoimmune disease, this inflammation can be triggered when it’s not needed.  Some of these materials can also increase the sensitivity to pain in the area.
• Pain:  Pain can be caused by a complex web of things when it comes to migraine.  But carrying on with the theme of inflammation, the pressure against nerves and stimulation of nerves is a part of the pain process.  Swelling can also cause problems in muscles and joints, making it hard and/or painful to move properly.  Loss of function can also simply be a result of pain.

Because the causes of pain are complex, it’s wise to talk to a doctor familiar with migraine about your treatment, instead of relying on over the counter "anti-inflammatories", which, when misused, can make the problem worse.  However, inflammation is a major player in the causes of migraine headache.

Check here for more on terminology and the causes of migraine headache.

Birmingham City University has a helpful page on inflammation.  Although it is more specifically about inflammation in injuries, it’s a helpful overview.

From the Headache and Migraine News Blog

My head feels hot, swollen, and it HURTS – why?!

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A recent study (actually, a study of studies, known as a systematic review and meta-analysis) published in the journal Cephalalgia suggests that the risk of dissection of the cervical artery is twice as high for people with migraine.  With all the links that have been found between migraine and heart disease, stroke, heart attack, and the like, it shouldn’t be a surprise that more links are being found.

What is cervical artery dissection?  The cervical arteries are a set of four major arteries in your neck.  Dissection occurs when the lining of one of these arteries becomes torn.  It can become serious when clots form in the tears.  Cervical artery dissection is a major cause of stroke in people under 50.

Because there are four arteries, even a clot often causes no problems.  But a dissection can cause severe headache, pain in your face and neck, and other symptoms.  Neck pain is often an early warning sign.

Because neck pain is common in migraine, sometimes a diagnosis of cervical artery dissection is missed.

If you’re experiencing symptoms of cervical artery dissection such as the above (stroke-like symptoms may be present as well), talk to your doctor.  She will examine you and ask about your medical history, and possibly send you for more tests (various scans and ultrasounds may be used).

Dissections may heal up on their own, or you may need to take medication to deal with clots.  But be sure to talk to your doctor if you think your symptoms may be more than migraine – especially if your symptoms have recently changed.

A summary of the study:  Migraine, migraine aura, and cervical artery dissection: A systematic review and meta-analysis
More about Cervical artery dissection

From the Headache and Migraine News Blog

Cardiovascualar System: More Links to Migraine?

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We’ve discussed probiotics here before, as part of the arsenal that could fight migraine in particular.  Probiotics are the good bacteria that comes in fermented foods like yogurt, as well as certain supplements.

Studies on how probiotics are used by the body suggest that they may have some very tangible health benefits (of course – we knew that!).  The head researcher, Professor Mark Lyte, points out:  "There is already evidence to suggest that the connection between gut microbes and the nervous system represents a viable route for influencing neurological function.  A recent study in mice, for example, showed that the presence of neurochemicals such a serotonin in the bloodstream was due to direct uptake from the gut."

Serotonin?  That’s a very common word in migraine research for sure.  Could this be one reason why probiotics are helping migraine patients?

Commenting on the research, Dr Gregor Reid writes:

Until recently the idea that probiotic bacteria administered to the intestine could influence the brain seemed almost surreal.  Yet in Lyte’s paper the concept is supported by studies showing that microbes can produce and respond to neurochemicals, which can induce neurological and immunological effects on the host.

The research presents an idea for selecting probiotic strains with neurological applications and linking this with immune-modulatory effects, while highlighting the fact that microbial strains already being widely ingested in fermented food can produce neurochemicals.

The moral of the story is that probiotics could fight not only migraine, but things like depression and anxiety.  That’s in addition to issues such as irritable bowel syndrome.

Could it be that in the future there will be specific migraine probiotic supplements?  I bet there will be – but before you buy them, wait until the research catches up with the marketing!

Meanwhile, try a quality brand of probiotics, such as these ones.

via A Gut-Full of Probiotics for Your Neurological Well-Being

From the Headache and Migraine News Blog

Probiotics: Fighting Migraine and More?

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In this podcast, James talks about pillows – their importance in relation to migraine and chronic headache, a little recent research, and a review of two (or three) types of pillows.

Some things mentioned in this podcast:

• Sleep Innovations Supreme Memory Foam Standard Pillow and X Memory Foam Pillow (UK)
• Best reviewed buckwheat hull pillow:  Bucky Buckwheat Bed Pillow
• One I’m seriously thinking about ordering:  Organic Buckwheat Pillow
• The Chillow and Chillow UK
• Other popular buckwheat pillows and buckwheat pillows in the UK
• Other popular memory foam pillows and memory foam pillows in the UK
• Why it’s important to get a new pillow
• More on buckwheat pillows

From the Headache and Migraine News Blog

The Practical Pillow Podcast

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